APPLICATION FORM
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APPLICATION FORM |
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| Name: Vladyslav | Surname: Raykov | ||||||
| Date of birth: 02.07.1982 | Place of birth: Melitopol | ||||||
| Permanent address: Kherson, Ukraine | |||||||
| Passport (OVIR): AT 27333 | Place of issue: Melitopol | Date of issue: 24.05.2002 | Valid until: 24.05.2012 | ||||
| Seaman’s book: AB 341217 | Place of issue: Odessa | Date of issue: 10.08.2006 | Valid until: 10.08.2011 | ||||
| Citizenship: Ukraine | Expiry date of U.S. visa: NO | ||||||
| Marital Status | Married | ||||||
| Next of kin: (name, pas. No) | wife - Raykova Nataly | ||||||
| Supported children under age of 18 | |||||||
| (name, surname, date of birth) | |||||||
| Knowledge of English language | Satisfactory | ||||||
| Education: | Qualification: | Date of Issue: | |||||
| Kherson Marine Institute | Navigator | 2005 | |||||
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Certificates of STCW 78/95 |
No. |
Place |
Date of issue |
Expiry date |
| Certificate of competency | 01095/2009 | Kherson |
06.11.2009 |
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| Endorsement STCW | 01095/2009 | Kherson |
06.11.2009 |
13.08.2014 |
| Personal Sea Survival (ÁÆÑ)(A-VI/1) | 15578/2009 | Kherson |
21.08.2009 |
21.09.2014 |
| G.M.D.S.S. General Operator (A-IV/2) Certificate | 00562/2009 | Odessa |
23.10.2009 |
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| G.M.D.S.S. General Operator (A-IV/2) Endorsement | 00562/2009 | Odessa |
23.10.2009 |
21.09.2014 |
| Radar Observation and Plotting (A-II/1,2) | 1640/2009 | Kherson |
10.09.2009 |
10.09.2014 |
| Automatic Radar Plotting Aids (ARPA) (A-II/1,2) | 1640/2009 | Kherson |
10.09.2009 |
10.09.2014 |
| Carrying dangerous & hazardous cargo (B-V/4, B-V/5) | 4059/2009 | Kherson |
13.08.2009 |
13.08.2014 |
| Advanced Fire Fighting (A-VI/3) | 7255/2009 | Kherson |
21.08.2009 |
21.08.2014 |
| Proficiency in Survival Craft, Rescue Boats & Fast Rescue Boats (A-VI/2) | 11362/2009 | Kherson |
21.08.2009 |
21.08.2014 |
| Medical First Aid (A-VI/4-1) | 5830/2009 | Kherson |
28.08.2009 |
28.08.2014 |
| Ship Safety Officer | 02384/2009 | Kherson |
20.08.2009 |
20.08.2014 |
| Ship Security Officer (ISPS) A/2.1.6,A/12.1,A/12.2,B/8,B/9,B/13 | 2760/2009 | Kherson |
26.08.2009 |
20.08.2014 |
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Tanker Certificates: |
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| Tanker Familiarization | 1273/09 | Kherson |
20.08.2009 |
20.08.2014 |
Sea Service (during five last years):
|
Name of vessel |
Company |
DWT |
Flag |
Type |
Position |
From |
To |
| Astoria | Global Shipping |
3245 |
Bahamas |
Pass |
OS |
14.10.2005 |
08.05.2006 |
| Astoria | Global Shipping |
3245 |
Bahamas |
Pass |
OS |
25.08.2006 |
13.03.2007 |
| Astoria | Global Shipping |
3245 |
Bahamas |
Pass |
AB |
12.07.2007 |
30.11.2007 |
| Astoria | Global Shipping |
3245 |
Bahamas |
Pass |
AB |
25.03.2008 |
06.09.2008 |
| Astoria | Global Shipping |
3245 |
Bahamas |
Pass |
AB |
12.11.2008 |
03.01.2009 |
| Experience at sea: Since 2002 | Knowledge Personal Computer: Yes | |||
| Medical Certificate: | ¹ | Issued: | Place: | Exp. date: |
| Vaccinationfor cholera valid until: | Vaccination for yellow fever valid until: 04.07.2012 | |||